Altarum Institute Survey of Consumer Health Care Opinions. Spring/Summer 2013

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1 Altarum Institute Survey of Consumer Health Care Opinions Spring/Summer 2013 Wendy Lynch, PhD, Christina Ciucci, MS, Michael Slover, MS Altarum Center for Consumer Choice in Health Care July 11, 2013

2 W. Lynch C. Ciucci M. Slover Altarum Institute Survey of Consumer Health Care Opinions Spring/Summer 2013 July 11, 2013

3 Table of Contents 1.0 Introduction Topics Methodology Respondents Demographics Health Insurance Self-Rated Health Evaluation Deductibles Concern over Coverage Alternative Medicines/Supplements Utilization History of Care Medications Decisions Overall Preferences Preferred Role in Decisions by Age Preferred Role in Decisions by Decision Type Active Involvement in Care Perceptions Perceptions about Physician Recommendations Perceptions about Treatment by Health Status Perceptions about Doctor Motivation Comfort and Confidence Resources in Selecting a Doctor Inquiring About Cost and Quality Comfort in Asking About Price Confidence in Finding Better or Less Expensive Care Trust Scale Altarum Institute Survey of Consumer Health Care Opinions Spring/Summer 2013

4 9.1 Trust Level by Demographics Trust Level by Response Trust Level for Comfort in Asking Price Trust Level for Alternative Medicines/Supplements Usage Comparing Service Experience with Doctors and Barbers/Hairdressers Implications Altarum Institute Survey of Consumer Health Care Opinions Spring/Summer 2013 ii

5 List of Exhibits Exhibit 1: Questions Evaluated for the Trust Index... 2 Exhibit 2: Marital Status... 3 Exhibit 3: Race/Ethnicity... 3 Exhibit 4: Self-Rated Health... 4 Exhibit 5: Annual Deductible... 4 Exhibit 6: Concern over Expense of Medical Bills... 5 Exhibit 7: Concern over Medical Bills by Those Who Forgot Medications Recently... 5 Exhibit 8: Concern over Medical Bills by Forget Medications Occasionally... 6 Exhibit 9: Use of Alternative Medicines/Supplements... 6 Exhibit 10: Medication Use... 7 Exhibit 11: Number of Prescriptions Taken by Participants... 8 Exhibit 12: Decision Preferences... 9 Exhibit 13: Preferred Role in Treatment Exhibit 14: Decision Preferences by Decision Type Exhibit 15: Involvement in Care Exhibit 16: Experiences Preparing for a Doctors Appointment Exhibit 17: Comfort and Confidence Exhibit 18: Perceptions about Treatment Exhibit 19: Perceptions about Treatment by Health Status Exhibit 20: Perceptions about Doctor Motivation Exhibit 21: Methods for Selecting a Doctor Exhibit 22: Asking About Quality and Price Overall Exhibit 23: Comfort in Asking Price Exhibit 24: Confidence in Choosing Better Doctors or Reducing Costs Exhibit 25: Mean Scores for Questions Indicating Trust Exhibit 26: Mean Scores for Questions Indicating Distrust Exhibit 27: Trust Index Distribution Exhibit 28: Trust by Age Group Exhibit 29: Mean Trust Scores for Active Role Exhibit 30: Decision Sharing Trust Scores by Decision Type Exhibit 31: Mean Trust Scores for Comfort in Asking Price Exhibit 32: Mean Trust Scores for Alternative Medicine Use Exhibit 33: Experiences with Doctors versus Hairdressers Exhibit 34: Choice of Doctor OR Hairdresser Exhibit 35: Choice of Doctor or Hairdresser When Doctor Reported as Not Listening Altarum Institute Survey of Consumer Health Care Opinions Spring/Summer 2013 iii

6 1.0 Introduction 2.0 Topics 3.0 Methodology The spring 2013 Altarum Survey of Consumer Healthcare Opinions is the fourth in an ongoing series of semi-annual surveys produced by the Center for Consumer Choice in Health Care (CCCHC). The goal of the series is to document consumer opinions about their role in health care decisions and factors that may influence their preferences and actions. This report covers several areas. To begin, it describes consumer health characteristics, cost sharing, health care utilization, and general perceptions about satisfaction with care. Next, it describes consumers preferred roles in decisions about health care and characteristics associated with wanting an active role. To better understand consumer characteristics, this report measured some aspects of personality and use of alternative medicine. The report explores some new areas regarding consumer opinions: (1) Level of engagement and confidence in managing their own health, for preventive care and minor and chronic illnesses. (2) Perceptions of physician motivation What drives the treatment options they recommend? (3) Service level and trust Do providers keep their best interests in mind and respect their time and pocketbook? The intent was to examine a broader set of domains that relate to, and possibly explain, differences in consumers preferred roles in health care. Respondents were paid participants from a nation-wide panel maintained by Survey Sampling International, Inc. Respondents came from diverse age groups, incomes, educational levels, and regions. The survey was administered via a website in April and May of A total of 2,592 participants took the survey. Responses for any participant whose patterns indicated either a lack of understanding or hasty completion were dropped from the sample. Specifically, those who answered in fewer than four minutes, answered fewer than 10 of the 20 literacy questions correctly, or self-reported the regular use of over ten alternative medications were removed from the survey results. This resulted in a total of 2,357 usable surveys. Participant responses were then evaluated individually as well as by such factors as gender, age, or income level to determine correlations. Responses to certain questions were also evaluated based on responses to other survey questions. Last, a trust index was created to determine how the respondents trust in their doctors affected their responses to other survey questions. The following questions were used in creating the index. Altarum Institute Survey of Consumer Health Care Opinion Spring/Summer

7 Exhibit 1: Questions Evaluated for the Trust Index Survey Question Response Options Trust/ Distrust Mean Score Doctors choose the treatments they recommend based on scientific evidence. Doctors choose the treatments they recommend based on how much they will be paid to give that treatment. Doctors choose the treatments they recommend based on past experience with other patients. Doctors choose the treatments they recommend based on what their patients want or ask for. Most of the Time or Always = 1. Trust Most of the Time or Always = 1. Distrust Most of the Time or Always = 1. Trust Most of the Time or Always = 1. Distrust In my experience, my doctors know what they are doing. Most of the Time or Always = 1. Trust In my experience, my doctors have my best interest in mind. Most of the Time or Always = 1. Trust In my experience, my doctors are motivated by money. Most of the Time or Always = 1. Distrust In my experience, my doctors respect my time and my budget. In my experience, my doctors listen to what s important to me. Most of the Time or Always = 1. Trust Most of the Time or Always = 1. Trust Have you experienced a doctor who didn t listen to you? Yes = 1 Distrust Have you experienced a doctor who recommended a treatment that didn t work? Have you experienced a surprise medical bill that was more expensive than you expected? Have you experienced waiting for care from your doctor for over an hour? Have you experienced becoming sicker or injured from the medication or treatment from your doctor? Yes = 1 Distrust Yes = 1 Distrust Yes = 1 Distrust Yes = 1 Distrust For questions with responses of Never to Always, choices Never, Rarely, and Sometimes were given a value of 0, while Most of the Time and Always were given a value of 1. For Yes/No questions, No were given a value of 0 and Yes a value of 1. A participant s trust score was calculated by taking the sum of their response scores for questions that revealed trust, and subtracting the sum of their response scores for questions that revealed distrust to create a composite score. Trust Scores = These values were then used to determine correlations between their level of trust and their demographics or responses. Altarum Institute Survey of Consumer Health Care Opinion Spring/Summer

8 4.0 Respondents 4.1 Demographics Respondents represented a diverse group of U.S. citizens. They ranged in age from 25 to 93, with a mean age of 44.9 years. Their income level ranged from $10,000 to more than $150,000 annually, and 99 percent of respondents were employed fulltime. The majority of respondents had been married (58%; Exhibit 2). Exhibit 2: Marital Status 6% 22% 14% 58% Married Sep/Div/Widowed Single Domestic partner The majority of respondents were White, with approximately six percent known to be Hispanic and seven percent African American. Exhibit 3: Race/Ethnicity 7% 6% 7% 80% White African American Hispanic Other 4.2 Health Insurance Of the 2,357 respondents, 91 percent had coverage from a Preferred Provider Organization (PPO) while the remaining nine percent had traditional insurance or an indemnity plan. Altarum Institute Survey of Consumer Health Care Opinion Spring/Summer

9 4.3 Self-Rated Health Evaluation Participants were asked to describe their health. The majority of participants described themselves to be in good or very good health (80%). Exhibit 4: Self-Rated Health In general, would you say your health is... 36% 44% 8% 12% Poor/Fair Good Very good Excellent 4.4 Deductibles Survey respondents reported their estimated deductible amount. Fifty percent of people believed their deductible to be between $500 and $4,000, while 14 percent did not know how much it was. Of those who knew the size of their deductible, only 7 percent stated that insurance paid the full amount. Exhibit 5: Annual Deductible How much is your annual health insurance deductible? 25% 25% 18% 14% 7% 7% 5% None (insurance pays all) $1-$500 $500-$1,000 $2,000-$4,000 $5,000 Above $5,000 I don't know Altarum Institute Survey of Consumer Health Care Opinion Spring/Summer

10 4.5 Concern over Coverage With the increasing cost of medical care, the majority of survey respondents reported they were somewhat or extremely concerned (65%) about their ability to pay for the bills their insurance does not cover. Only 10 percent had no concerns. Exhibit 6: Concern over Expense of Medical Bills If you were to have a serious health problem, how concerned are you about your ability to pay for the bills your insurance doesn't cover? Extremely concerned 30% Somewhat concerned 35% A little concerned 25% Not at all concerned 10% However, when the level of concern over paying the medical bills insurance did not cover was evaluated against those who had forgotten to take their daily medication in the last two weeks, those who were more concerned were also more likely to forget to take their medication (32% versus 22%). Exhibit 7: Concern over Medical Bills by Those Who Forgot Medications Recently Concern about Ability to pay bills insurance doesn't cover by Sometimes forgot to take daily medication in the past 2 weeks Yes Extremely concerned 32% Somewhat concerned 27% A little concerned 22% Not at all concerned 22% Altarum Institute Survey of Consumer Health Care Opinion Spring/Summer

11 This same pattern was also found for those who stated that, in general, they sometimes forgot to take their daily medications (41% versus 32%). Exhibit 8: Concern over Medical Bills by Forget Medications Occasionally Concern about Ability to pay bills insurance doesn't cover by Sometimes forget to take daily medication Extremely concerned 41% Yes Somewhat concerned 38% A little concerned 38% Not at all concerned 32% 4.6 Alternative Medicines/Supplements Many people prefer to use alternative medicines and supplements. These include Creatine, DHEA, Echinacea, Primrose, Glucosamine, Goat Weed, and Goldenseal, among others. Sixty-four percent of participants did not use any alternative medicines or supplements. A quarter of respondents reported using one or two alternative medicines regularly. Exhibit 9: Use of Alternative Medicines/Supplements Percentage of participants who regularly use alternative medicines/supplements 9% 16% 4% 7% 64% No alternative meds 1 alternative med 2 alternative meds 3 alternative meds 4+ alternative meds Altarum Institute Survey of Consumer Health Care Opinion Spring/Summer

12 5.0 Utilization 5.1 History of Care 5.2 Medications Health care utilization rates varied considerably. The majority of respondents (81%) have received advice or services from a nurse, doctor, or hospital in the last 12 months and 71 percent have been to a medical clinic or doctor s office for an illness in the last year. A small percentage of respondents (11%) have stayed overnight in a hospital in the past year. The majority of participants have been prescribed a daily medicine by their doctor (64%). When asked whether a doctor had given direct advice, 83 percent have been recommended a specific medication or treatment. Comparatively, only 55 percent of respondents were given options for treatment or medication by their doctor at the time of prescription. Exhibit 10: Medication Use Yes Medications Do you take any medication prescribed by a doctor? 66% Has your doctor prescribed you a medicine you are supposed to take every day? 64% Has a doctor ever recommended a specific medical treament or medication to you? 83% Has a doctor ever given you more than one option of treatment or medication and invited you to choose among them? 55% Of those participants on medication, over half (60%) take two or fewer prescriptions regularly. Altarum Institute Survey of Consumer Health Care Opinion Spring/Summer

13 Exhibit 11: Number of Prescriptions Taken by Participants How many prescription medications do you take on a regular basis? 34% 26% 15% 9% 5% 3% 2% 2% 1% 1% 6.0 Decisions It is common for people to occasionally forget to take their medications. Twentyseven percent of participants taking daily medications reported forgetting to take their medication in the last two weeks and38% reported they have not taken their medications for any reason. 6.1 Overall Preferences Almost all participants (99%) reported wanting to play at least some role in medical decisions about their care. Some want to be in complete charge of decisions (22%), while others want to make final decisions with doctor input (38%) or make joint decisions about care with their doctors (32%). Only 7% want doctors to make the decisions (with their input), and 1% prefer to have the doctor be in complete control. Altarum Institute Survey of Consumer Health Care Opinion Spring/Summer

14 Exhibit 12: Decision Preferences Some people like to take control of their decisions about medical treatment, while others want their doctors to take the lead. What rold would you prefer to play in important decisions about your medical treatment? I want... 7% 1% 22%...to be completely in charge of my decisions....to make the final decision with some input from doctors and other experts. 32%...to make a joint decision with equal input from my doctor. 38%...my doctor to make the decisions, with input from me....the doctor to be completely in charge of treatment decisions. 6.2 Preferred Role in Decisions by Age When examining the participants preferred role by age group, younger repsondents prefer to have more control over their care than older participants. While 27 percent of those ages 25 to34 prefer to be completely in charge of their decisions, only 15 percent of participants ages 55 to 64 chose this response. However, while only 28 percent of those ages 25 to 34 prefer joint decision-making with the doctor, 37 percent of respondents ages 55 to 64 preferred this choice. Altarum Institute Survey of Consumer Health Care Opinion Spring/Summer

15 Exhibit 13: Preferred Role in Treatment Some people like to take control of their decisions about medical treatments, while others want their doctors to take the lead. What role would you prefer to play in important decisions about yoru medical treatment? I want yrs yrs yrs yrs 27% 26% 22% 15% 41% 37% 37% 39% 35% 37% 28% 26% 6% 7% 8% 5% 1% 1% 2% 1%...to be completely in charge of my decisions....to make the final decision with some input from doctors and other experts....to make a joint decision with equal input from my doctor....my doctor to make the decisions, with input from me. The participant s desired role did not vary when evaluated by income level. And only slightly more male participants preferred to be completely in charge of their medical decisions than female participants (26% versus 19%). 6.3 Preferred Role in Decisions by Decision Type...the doctor to be completely in charge of treatment decisions. Participants preferred role in their medical decisions also varied depending on what type of issue they discussed with their doctor. Participants wanted more control in making all decisions pertaining to mild illnesses and healthy lifestyles (38% and 27%, respectively) but wanted to share decisions equally with their doctors when it came to preventing and treating chronic diseases (35%). Altarum Institute Survey of Consumer Health Care Opinion Spring/Summer

16 Exhibit 14: Decision Preferences by Decision Type When it comes to making medical decisions, how much do you prefer to make your own decisions, and how much do you prefer the doctor to make the decisions for you? I want... (by decision type) Preventing and treating chronic diseases. Preventing and treating mild illnesses. How to lead a healthy lifestyle. 23% 35% 28% 22% 23% 38% 31% 38% 27% 7% 2% 1% 7% 5% 12% all decisions made by doctor. decisions mostly made by doctor, some input from me. decisions made equally by doctor and me. decisions mostly all decisions made made by me, some by me. input from doctor. 6.4 Active Involvement in Care It is important for patients to understand that they can affect their health outcomes and prepare themselves with knowledge prior to meeting with their doctors to better understand their situation and aid them in asking relevant questions. Over threequarters of respondents believe they handle their health well and 88 percent take responsibility for their health. That said, 38 percent of people felt that their health was their business and did not like people telling them how to be healthy. Seventyone percent of participants felt they were generally able to accomplish goals for their health, and, that when they worked to improve their health, they succeeded. The majority of participants (62%) also take advantage of help from either their employer or their health plan. Altarum Institute Survey of Consumer Health Care Opinion Spring/Summer

17 Exhibit 15: Involvement in Care Participants' Opinions on Controlling their Health (Agree/Strongly Agree) I handle my health well. 76% I take responsibility for my health. 88% My health is my business. I don t like when people tell me how to be healthy. 38% I'm generally able to accomplish goals for my health. When I work to improve my health, I succeed. When my health plan or employer offers to help me with my health, I take 62% 71% 71% When participants were asked about their experiences, 68 percent agreed or strongly agreed that they had researched their condition prior to their doctor visit, and 47 percent have brought information about their health with them to their appointments. Seventy-one percent of participants prepare questions before they visit their doctors, and 73 percent agree or strongly agree that different doctors give different advice and it is up to them to choose what is right for themselves. Exhibit 16: Experiences Preparing for a Doctors Appointment Participants' Experiences (Agree/Strongly Agree) I learn as much as I can about my health conditions before I see my doctor. 68% I have brought my own information about my health to show my doctor. 47% I prepare questions before I see my doctor. 71% Different doctors give different advice. It's up to me to choose what's right for me. 73% Altarum Institute Survey of Consumer Health Care Opinion Spring/Summer

18 Overall, approximately 90 percent of survey participants felt comfortable talking to their doctors about their health as well as taking an active role in their health. Only 56% agreed they could stick with plans to exercise and eat a healthy diet. The majority of respondents, however, did agree that they would know what to do if they had a problem with their health (70%) and would be able to find answers when they have questions about their health (87%). Exhibit 17: Comfort and Confidence Participants Agree/Strongly Agree: I feel comfortable talking to my doctor about my health. 90% I take an active role in my own healthcare. 87% I can stick with plans to exercise and eat a healthy diet. 56% I am confident I would know what to do if I had a problem with my health. 70% When I have a question about my health, I find the answer. 87% 7.0 Perceptions 7.1 Perceptions about Physician Recommendations Survey respondents were asked about their perceptions of doctors motivation for treatment recommendations. When evaluating responses of Always, Most of the Time, or Sometimes, almost all respondents believe that doctors choose the treatments they recommend based on scientific evidence that the treatment works or experience with other patients (97% each). Approximately three-quarters of repondents believe doctors recommend treatments based on how much they will be paid to give it (74%) and 87 percent think they choose the treatment based on what their patient wants or asks for. Altarum Institute Survey of Consumer Health Care Opinion Spring/Summer

19 Exhibit 18: Perceptions about Treatment Doctors choose the treatments they recommend based on... Always Most of the time Sometimes 97% 74% 97% 87% 29% 32% 58% 52% 54% 60% 18% 24% 10% 5% 11% 4% scientific evidence that the treatment works. how much they will be paid to give that treatment. experience with other patients. what their patients want or ask for. 7.2 Perceptions about Treatment by Health Status Comparing perceptions about doctors by patient s health status, those in very good health had a higher perception than those in poor health that doctors chose treatments based on scientific evidence (24% higher), experience with other patients (44% higher), and what the patients want or ask for (23% higher). Those in poor health had a stronger belief that doctors prescribe treatments based on how much they will be paid to give the treatment than all other health status groups did. Exhibit 19: Perceptions about Treatment by Health Status 50% 70% 74% 70% 64% Doctors choose the treatments they recommend based on (response "most of the time/always" by health status) Poor Health Good Health 39% 29% 21% 20% 24% 44% Fair Health Very good Health 67% 68% 61% 62% 34% 26% 29% 22% 11% scientific evidence that the treatment works. how much they will be paid to give that treatment. experience with other patients. what their patients want or ask for. Altarum Institute Survey of Consumer Health Care Opinion Spring/Summer

20 7.3 Perceptions about Doctor Motivation The majority of participants believe doctors know what they are doing (78%) and have the patient s best interest in mind (76%). Less than a quarter believe doctors are motivated by money (21%). Less than half (46%) of participants believe that doctors respect their time and budget, while only 64 percent believe doctors listen to what is important to the patient. Exhibit 20: Perceptions about Doctor Motivation 78% 76% In my experience, my doctors.. 64% 46% 21% know what have my best are motivated they are doing. interest in mind. by money. respect my time and my budget. listen to what's important to me. 8.0 Comfort and Confidence 8.1 Resources in Selecting a Doctor Friends and family are still the predominant source of information in selecting health care. Over 75e percent of participants reported having selected their doctor based on opinions from friends or relatives. By comparison, approximately 20 percent researched online ratings from experts about clinical quality or the doctor s bedside manner or waiting time. Least used were advertisements, and only 14 percent used information comparing the cost of care in selecting their doctor. Altarum Institute Survey of Consumer Health Care Opinion Spring/Summer

21 Exhibit 21: Methods for Selecting a Doctor Have you ever used any of the following to choose a doctor? Yes Information comparing the cost of care. Online ratings from experts about clinical quality. Online ratings of a doctor's bedside manner or waiting time. 14% 21% 24% Advertisements in newspapers, magazines, or television. 8% Opinions from friends or relatives. 75% 8.2 Inquiring About Cost and Quality Participants were asked if they have ever asked how much their visit would cost BEFORE going to the doctor. Forty-eight percent answered that they had. Of those who received advice or services in the last year, 35 percent of those had asked what the cost would be prior to their visit. The same percentage had also looked for doctor quality ratings prior to their visit. Exhibit 22: Asking About Quality and Price Overall When you received advice or services from a nurse, doctor, laboratory or hospital in the past 12 months... Yes did you ask BEFORE your visit what the cost would be? 35% did you look for information about ratings of doctor quality before choosing where to go? 35% Altarum Institute Survey of Consumer Health Care Opinion Spring/Summer

22 8.3 Comfort in Asking About Price Participants were asked how comfortable they would be asking their doctor before the visit how much their treatment would cost. Overall, 82 percent were somewhat or very comfortable in doing so. Exhibit 23: Comfort in Asking Price How comfortable would you be asking your doctor about how much your treatment will cost? 4% 46% 15% 35% Very uncomfortable Somewhat uncomfortable Somewhat comfortable Very comfortable 8.4 Confidence in Finding Better or Less Expensive Care When asked about their confidence in finding more qualified doctors by comparing their results, 58 percent of participants believed that they could. However, only 36 percent believed that they could actually reduce the cost of health care by shopping for better prices. Altarum Institute Survey of Consumer Health Care Opinion Spring/Summer

23 Exhibit 24: Confidence in Choosing Better Doctors or Reducing Costs Confidence Level - Very/Somewhat Confident How confident are you that you can choose more qualified doctors by comparing their results? 58% How confident are you that you can reduce your cost for health care by shopping for better prices? 36% 9.0 Trust Scale As discussed in the Methodology section, certain survey questions were evaluated to determine a participant s level of trust in their doctor. A summary of the mean scores for questions indicating trust and distrust are presented here. Exhibit 25: Mean Scores for Questions Indicating Trust In my experience, my doctors respect my time and budget In my experience, my doctors listen to what's important to me. Doctors choose the treatments they recommend based on experience. Doctors choose the treatments they recommend based on scientific evidence. In my experience, my doctors have my best interest in mind. In my experience, my doctors know what they are doing Altarum Institute Survey of Consumer Health Care Opinion Spring/Summer

24 Exhibit 26: Mean Scores for Questions Indicating Distrust Have you experienced becoming sicker or injured from the medication or treatment from your doctor? 0.10 In my experience, my doctors are motivated by money. Doctors choose the treatments they recommend based on how much they will be paid to give that treatment. Have you experienced a doctor who didn t listen to you? Have you experienced a doctor who recommended a treatment that didn t work? Have you experienced a surprise medical bill that was more expensive than you expected? Doctors choose the treatments they recommend based on what their patients want or ask for Have you experienced waiting for care from your doctor for over an hour? 0.45 The sum of the means for questions that indicated trust was 3.97, while the sum of the means for distrust questions was This resulted in an overall average trust score of 1.95 on the index, with a minimum of 7 and a maximum of 6. Altarum Institute Survey of Consumer Health Care Opinion Spring/Summer

25 Total Trust Score Exhibit 27: Trust Index Distribution Trust Index Mean % 20% 40% 60% 80% 100% Trust Score 9.1 Trust Level by Demographics On examination, gender and trust do not appear to correlate. However, age appeared to affect a participant s trust level. Those in lower age groups had a higher level of trust for their doctors (35%) than older participants (16%). Exhibit 28: Trust by Age Group Level of Trust by Age Group Least Trusting Less Trusting More Trusting Most Trusting 12% 14% 18% 27% 30% 31% 26% 22% 22% 35% 34% 28% 29% 38% 34% 34% 19% 13% 19% 16% 25-34yrs 35-44yrs 45-54yrs 55-64yrs 65+ yrs 9.2 Trust Level by Response When evaluating respondent s likelihood to take advantage when a health plan or employer offered to help them with their health, those with a higher level of trust were more likely to take advantage of the offer. Altarum Institute Survey of Consumer Health Care Opinion Spring/Summer

26 When participants were asked to agree or disagree with the statement My health is my business. I don t like when people tell me how to be healthy, those who disagreed with this statement tend to have a higher level of trust. In other words, those who are more trusting were more likely to accept advice and participate in programs when offered. Exhibit 29: Mean Trust Scores for Active Role Mean Trust Scores for Active Role 1.12 Strongly Disagree Neither Agree/Disagree Strongly Agree Disagree Agree When my health plan or employer offers to help me with my health, I take advantage. My health is my business. I don't like when people tell me how to be healthy. Last, participant s responses to How much do you prefer to make your own decisions and how much do you prefer the doctor to make decisions for you? were evaluated based on their trust score. When decisions regarded preventing and treating mild illnesses, leading a healthy lifestyle, or preventing and treating chronic illnesses, those who wanted the doctor to make all the decisions had the highest trust scores (2.17, 2.29, and 2.31, respectively). Those with lower trust scores preferred to make all decisions themselves (1.87, 1.57, and 1.27, respectively). The differences observed increased as the severity of the decision discussed increased. Altarum Institute Survey of Consumer Health Care Opinion Spring/Summer

27 Exhibit 30: Decision Sharing Trust Scores by Decision Type 3 Decision Sharing Mean Trust Scores by Decision Type All decisions made by doctor Decisions mostly made by doctor, some input from me 1 Decisions made equally by doctor and me 0.5 Decisions mostly made by me, some input from doctor 0 Preventing and treating mild illnesses, such as cold or flu How to lead a healthy lifestyle Preventing and treating chronic diseases All decisions made by me 9.3 Trust Level for Comfort in Asking Price When reviewing participant s responses to how comfortable they would be asking their doctor about how much their treatment would cost, those with the highest trust level (1.99) were the most comfortable in asking. Those who were very uncomfortable had the lowest trust score (1.69). Exhibit 31: Mean Trust Scores for Comfort in Asking Price "How comfortable would you be asking your doctor about how much your treatment will cost?" Very uncomfortable Somewhat uncomfortable Somewhat comfortable Very comfortable 9.4 Trust Level for Alternative Medicines/Supplements Usage Participant s use of alternative medicines and supplements was evaluated based on trust levels. Twenty-three percent of those who used few alternative medicines were in the top quarter of the trust index, where only 10 percent of those that were regular Altarum Institute Survey of Consumer Health Care Opinion Spring/Summer

28 alternative medicine users were. Forty-eight percent of those who used few alternative medicines were in the lower half of the trust index while sixty percent of regular alternative medication users were. Overall, participants who regularly use alternative medicines tend to be less trusting. Exhibit 32: Mean Trust Scores for Alternative Medicine Use Least Trusting Less Trusting More Trusting Most Trusting 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% 23% 18% 10% 30% 30% 31% 28% 19% 23% 29% 28% 32% Very Low Alt Med Use Moderate Alt Med Use Regular Alt Med Use The concept of trust, defined here by a combination of opinions about doctors motivation and care experiences, suggests a tension may exist between trust and key aspects of engagement. While consumers with higher levels of trust reported being more likely to take advantage of health programs when offered, they were less likely to take a more active role in decisions, ask about the cost of care, or use alterative medications and services. Those who were least trusting were most likely to say they wanted to be the primary decision-maker about chronic illness and ask about the cost of care. Lower trust was associated with a personality that is higher in neuroticism (fearful). The connection of active engagement with distrust presents a challenge in positioning active involvement as a prudent behavior, without casting providers in a negative light or suggesting that consumer should be fearful of medical care Comparing Service Experience with Doctors and Barbers/Hairdressers To assess the degree to which consumers perceive service experiences with doctors differently than other types of service providers, participants were asked a series of similar questions about service experiences with both their doctor and their hairdresser or barber. In general, respondents reported poor service more often from their doctors than their hairdresser. Twenty-four percent of respondents reported having a doctor that did not listen to them while only 18 percent had experienced this at their hairdresser A quarter of respondents reported their doctor had recommended a treatment that did not work while only 11 percent had a product recommended by their hairdresser that did not work. Over a quarter of respondents reported a surprise medical bill whereas only nine % reported this from the salon. While 45 percent had Altarum Institute Survey of Consumer Health Care Opinion Spring/Summer

29 waited over an hour for their doctor at their appointment, only thirteen percent had experienced this at their hairdresser. Last, 10 percent of participants reported their treatment from either their doctor or hairdresser harmed their hair. Exhibit 33: Experiences with Doctors versus Hairdressers I have experienced the following: Hairdresser Doctor A doctor/hairdresser who didn't listen to me 18% 24% A doctor who recommended a treatment that didn't work/a hairdresser who recommended a product that didn't work A surprise bill that was more expensive than expected 9% 11% 25% 27% Waiting for care from a doctor/service from a hairdress for over an hour You got sicker or injured from the medication or treatment/your hair was harmed from the cut or hair treatment 10% 10% 13% 45% Despite the lower quality services, when forced to choose, 76 percent of respondents would choose to keep their doctor over their hairdresser, almost a quarter of respondents would choose their barber/hairdresser. Exhibit 34: Choice of Doctor OR Hairdresser If you could keep your current doctor OR your current barber/hairdresser, but not both, which would you keep? Hairdresser 24% Doctor 76% Altarum Institute Survey of Consumer Health Care Opinion Spring/Summer

30 Isolating those respondents who reported that their doctor did not listen to them (24% of respondents), over one-third of those would keep their hairdresser over their doctor. Exhibit 35: Choice of Doctor or Hairdresser When Doctor Reported as Not Listening In my experience, my doctor doesn't listen to me. If I could keep my current doctor OR hairdresser, I would keep [which]? Doctor 63% Hairdresser 37% 11.0 Implications Four main themes emerge from this survey, each of which has implications regarding consumerism: 1. Consumers have an active interest in participating in their treatment decisions. While most want some degree of collaboration with their providers, a majority want primary control. This preference is especially true for minor health issues and for younger and healthier patients. 2. Consumers report high levels of involvement and interest in health issues. A majority report learning about and preparing for visits and treatments. Most report feeling capable of finding answers about health issues and knowing what action to take when facing a new health problem. Despite high confidence levels in many areas, however, there are other areas where consumers do not report taking an active role. Less than half have brought information to a doctor s visit, and less than half have asked about the cost of care prior to a visit. 3. In general, consumers believe that physicians make treatment recommendations based on evidence and experience. A minority feel that physician recommendations are driven by motivation for higher income or simply because the patient asks. Most also believe that their physician has their best interests in mind (76%) and listen to their concerns (64%). Conversely, fewer believe their doctor respects their time. In addition, between 20 percent and 45 percent report having negative experiences at the doctor s offices, including long waits, not being listened to, or a surprising bill. Interestingly, consumers report higher rates of negative service experiences with their doctor than with their barber or hairdresser. Altarum Institute Survey of Consumer Health Care Opinion Spring/Summer

31 4. Trust in physicians actions and motivations vary. Questions about physician motivation and negative experiences were combined into a trust scale. Level of trust is related to consumer s preferred role (less trust means wanting more say in all types of decisions), and willingness to participate in health programs offered by their employer (less trust means lower willingness). The implication of this relationship is that higher levels of engagement correspond with lower levels of trust in doctors. Whether this suggests that consumers must become less trusting to become in engaged is uncertain. Consumer perceptions about health care remain varied and often contradictory. For example, a majority of respondents report feeling confident they can find higher quality care online, yet very few report having done so. Similarly, a majority say they would be comfortable asking about the price of care, yet less than half have actually asked. There are relatively high levels of trust in the motivations of physicians, but one in five does agree that decisions by medical professionals are motivated by money. Only about half agree that their physician respects their time and budget. Consumers tolerate lower levels of service by their medical providers than by their hairdressers. Conversely, despite experiencing poor service (waiting, not being listened to, getting charged more than expected), a large majority feel more loyalty to their physician than their hairdresser. Much remains to be understood about the engagement and perspectives of consumers in health care. This report underscores how widely some opinions vary, yet how uniformly most consumers wish to play an active role in decisions about their health. Altarum Institute Survey of Consumer Health Care Opinion Spring/Summer

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